Because dry eye is a chronic condition, it is important to see an eye care specialist for treatment.
“Left untreated, in severe cases, dry eye disease can cause progressively worse symptoms and damage to the ocular surface, including conjunctival and corneal scarring, ulceration and visual loss,” says Vincent de Luise, M.D., an ophthalmologist who teaches at Yale Medical School.
Fortunately, eye care providers have a variety of interventions available—and more in the pipeline—for the treatment of dry eye.
Artificial tears and ointments: Also called eye drops, artificial tears are the first line of treatment for mild cases of dry eye. They also are used to keep the eye lubricated after vision correction surgery and cataract surgery. The Food and Drug Administration has approved two prescription-only treatments for dry eye. Restasis treats dry eye caused by reduced tear production. Xiidra, which was approved in July 2016 and treats the symptoms and the signs of dry eye, will be available starting in late 2016. There also are numerous over-the-counter eye drops available in varying thicknesses; the thicker gel-like products last longer but primarily are used at night as they cause blurred vision. Many eye drops contain preservatives that can irritate the eye. The best are preservative-free (also called non-preserved) artificial tears.
Off-label treatments: Some medically prescribed eye care treatments are what is known as “off-label.” They are approved by the FDA for another purpose, but doctors can legally prescribe them as long as they are in the best interest of the patient. Off-label treatments for dry eye include short-term use of steroids and antibiotics to manage meibomian gland dysfunction.
Punctal plugs: For people whose tears evaporate too fast, plugs made of collagen, silicone or other materials can be inserted into the tear ducts to prevent the eyes from draining. This keeps the ocular surface moist longer, especially when used in combination with artificial tears. A variety of different plugs exits; some block eye drainage completely, others slow it down.
Adjusting medications: Sometimes the medicines people take for other conditions, such as for allergies or depression, can contribute to dry eye. Your dry eye specialist may need to work with your other doctors to adjust your medicines in order to find relief. The FDA has approved Restasis, a topical eye drop used to improve tear quantity in patients with dry eye disease due to inflammation.
Surgical procedures: A growing array of interventions are available to open up the meibomian glands, the glands that produce the lipids in tears. A device called LipiFlow warms the eyelid margin to help liquefy the secretions from clogged glands. Intense pulsed light (IPL) is also effective for stimulating the meibomian glands in people who have meibomian gland dysfunction often associated with acne rosacea. For severe cases, surgeries to permanently close the tear ducts can be performed on an outpatient basis.
Changing contact lens use: Contact lens wearers frequently experience dry eye, sometimes due to sleeping while wearing contacts or touching their eyes without washing their hands. But in other cases, it’s the lens itself or its ingredients that can irritate. “We recommend patients reduce their contact lens wearing time and consider only wearing daily disposable contact lenses,” says Dr. de Luise. “This reduces the risk of infection.”
Autologous serum drops: This treatment for severe dry eye, which is not yet covered by insurance, involves preparing eye drops from a patient’s own plasma. The drops lubricate the eye and deliver nutrients not available in artificial tears.
Emerging treatments: “There are also several exciting strategies in the pipeline for dry eye disease,” says Dr. de Luise. The FDA currently is reviewing a new multi-dose version of Restasis, as well as analyzing the clinical trials of Lifitegrast, a medicine that reduces the inflammation that can cause dry eye. A nasal device that increases tear production is expected to hit the market in 2017. In addition, researchers are exploring novel ways to use existing therapies for dry eye. “There is promising research going on in the use of topical NSAIDS and the short-term use of topical safe corticosteroids,” says Dr. de Luise.